UPDATE 1/20/05
Well it has now been about 6 months since Princess entered treatment at the UC Davis Veterinary Medicine Teaching Hospital for Lymphoma and she has enjoyed an excellent quality of life. She eats eagerly and enjoys going for moderate length walks. She naps a lot, like any dog her age, and there are an abundance of dog cushions throughout my house. She gets along with my other dogs, though she does not interact with the younger ones much. She has Sage, who will be 14 on Feb 15, as a sedate companion. The one thing she lacks for her happiness is a cat to curl up with, but becasue of some of my other dogs trying to bring a cat in would be hazardous to the cat's health.
Her chemotherapy treatments have, unfortunately , caused a great deal of her hair to fall out. (Most dogs do not lose hair from chemo ; but apparently some breeds, such as Poodles and Bouvs, which tend to grow hair continually do lose hair. This is not the first Bouv I have known to lose hair from chemo.) So for our cool California winters (typically 40šF to 55š F outdoors during days and about 50š to 65š F indoors, being warmer in the room with the woodstove than in the rest of the house), she is wearing a plaid coat that helps retain body heat. Apparently she is comfortable , as I don't see her trying to hang out close to the woodstove as she would if she felt chilly. Come summer, I will have to put sunscreen on her naked spots when we go out for a walk. Anyway, her condition does not seem to bother her, so I just make jokes that being one of the "Bare Naked Bitches" is better than being one of the "Tragically Hip Dysplastic" and that neither of these is a new Canadian music group to whose music Kurt Browning will be skating this season . (If you don't get these jokes, then you are neither Canadian nor a skating fan.)
At her most recent visit to the UC Davis CCAH Cancer Center, because her lymph nodes were getting larger again, a sign that her remission is becoming incomplete, her drugs were changed. We hope this will get her back into full remission. Her quality of life is still excellent and we will do our best to keep it that way as long as we can.
I recently learned that her birthday is Feb 19, 1991. So she will soon be 14 years old and still enjoying life. (My other old dog, Sage, will be 14 a few days earlier, on the 15th.) Eventually the lymphoma will outwit the oncologists and will take over again, unless of course something else gets her first. She will remain as my guest to spend whatever remains of her life in comfort and dignity. By Rescue standards and by my own, this has to be accounted a victory.

UPDATE 2/14/05 : At her last visit, two weeks ago, her nodes were back down again. The change of medication is working. Below I show her in her coat and naked.

Naked from chemotherapy.

Clothes make the dog !

UPDATE 4/18/05. A week ago, I found that Princess's lymph nodes had enlarged again, so I got her into the VMTH to have this confirmed by her oncologist, Dr Gabriella Sifiligoi. So she got another treatment with Elspar, a drug that is usually the first used in the beginning of treatment and usually the first to use when remission seems to be faltering. Usually there is some response within 2 days, and sure enough two days later her neck nodes seemed smaller to my fingers. Also her prednisone dose is doubled for a week , to then be cut back to 150% for the next week, then back to her previous dose.
 
Yesterday , as described in Sage's story, I came home to find Princess had fallen and not been able to get up. (She had seemed absolutely her normal self that morning.) She was trapped against an obstacle, and there was a wet spot under her -- I didn't need to give it the sniff test to know it was urine, which I would expect in view of the increased pred dose (pred causes increased urination and normally corresponding increased water intake ; urine is usually pretty diluted so not much smell). So I helped her to get up. Her left hind leg slid out from under her, slid inwards towards center. We tried this a few more times, with same result. She could walk only a few steps before that leg slid out from under her. So , since I was taking Sage in to the VMTH on an emergency admission , I asked to bring her too. Used Sage's Walkabout rear end supporter to help her walk to the car, then lifted her in to a cushioned nest in the front seat. Off to the VMTH , where Sage needed to be seen first. Princess was not in any distress or danger, but I did want to know why her hind leg was failing her.
 
After Sage's evaluation and The End of his story, it was Princess' turn for attention.
 
Well, she was somewhat dehydrated, which might have come about if she had fallen and been trapped early in the day and so unable to go to any of the water bowls to drink to replentish the prednisone increased urine output. And chest and abdominal radiographs showed that a lot of the deeper body lymph nodes in chest and abdomen were also enlarged relative to normal. Her palpation acessible nodes were still larger than normal but smaller than recorded prior to her Elspar treatment. No clear reason for her hind leg to be doing its slip-sliding away trick. We admitted her to the hospital so she could be on IV fluids and be seen by Oncology and Neurology next day.
 
Today it is the following day. I've heard from Oncology. Dr Sfiligoi , her usual treating oncologist had felt her nodes and agreed that they were smaller than before the Elspar. Since Elspar reached every part of the body, including the brain and spinal fluid, any lymphoma that might have gotten into her spinal cord or be affecting the leg nerve which if damaged could cause that inward slip-slide would also be receiving the drug and should be also responding. She still as of this morning was having trouble with the leg. And she wasn't interested in eating -- which scares me ! She is to be seen by Neurology sometime later today. I probably won't hear about it until after attending Shelter Med 101 at 5 to 6 pm. I will go from there to the VMTH.
 
If she does not regain better use of the leg, then I have to let her tell me how this affects her own opinion of her quality of life. Dogs with severe mobility deficits can react a number of different ways : some with fear, some with great depression or loss of hope, and some accept it gracefully and calmly and rely on their people to help them. I think she will be one of those who can accept it with grace, and if so, then I should be able to maintain enough quality in her life. But the Great Dark at the end of the tunnel is now very much within view. She was diagnosed 8/13/04, so has had 8 months of really good quality remission and good quality enjoyable life , life with very little distress and much low keyed enjoyment. That is a damn good salvage for a dog her age, which is now 14 years 2 months, which is very ancient for a Bouvier.
 
But I would sure appreciate it if she could come back to me for a while. She is a sweet girl.

UPDATE 4/19/05. Rejoicings !!!! My sweet little girl has a reprieve and has some good quality living still left to her !
 
At mid-morning yesterday she was just barely able to stand up and at mid-afternoon just able to walk a little in a very wobbly fashion (the technical term being "ataxia", meaning "Ah (I) need to call a taxi because ah (I )can't walk very well"), which was the point she was at when Neurology examined her. Neurology gave about 5 possible explanations ("differential diagnosis") for her symptoms and said it would take a CSS (cerbral spinal fluid) tap and an MRI to distinguish between these possibilites, though even so the answer might not be correct, and for several of the possible conditions, there was little that could be done or for some of them what could be done (spinal surgery) should not be done (long painful recovery, ie ruining what short period of life her lymphoma is likely to allow). The CSS tap by itself would give a partly reliable answer (significant incidence of false positives and false negatives) as to whether the lymphoma had gotten into her spine, and if so there was only one remaining drug ("Cytasar" -- spelling ? ) worth trying, the only one that can cross into the spinal fluid, and that one while known to be effective in humans had not yet been much used in dogs and the best way to give it was still very uncertain becaus3 the phamokinetics of how it enters and leaves the spinal fluid are not known. The CSS tap would show reliably wether or not the problem was something infectious and/or inflamatory and if so that would be treatable. The MRI would show a fibrous embolism (which would be treated by cage rest and hoping for the best) or a solid tumor (painful surgery : won't do that to her !) or a disc problem (painful surgery : won't do that to her !). Both MRI and CSS tap require anesthesia, with some very small risk of death from the anesthesia , a risk I would consider acceptable. The CSS tap could be done next day, but wait period for MRI is 2 weeks, by which time she could be enough worse that I would have euthanized her or enough better that we wouldn't need to do it.
 
Are we having fun yet, students ? Dr Grant and I agreed that the MRI was not worth doing, as it would not lead to any helpful treatment decisions. But the CSS tap probably was worth doing, as it could lead to useful treatment decisions. I then asked to visit her, both because I wanted to visit her to hug and cuddle with her and because I needed to evaluate her attitude, ie fearful vs depressed vs calm +/or cheerful, and to evaluate her ability to stand and walk. After all, Dr Grant had never seen the "Before" and could not compare it to the current picture, as I had no video to show him. Only I could compare her present ability to what was normal for her previous to this "incident". Good vets respect that the client, the dog's caretaker-guardian, almost always has information to contribute that can be valuable and that is not known or accessible to the vet. Dr Grant is most definitely a good vet !
 
Hallejullia ! She could stand easily and securely and she could walk as well or maybe a bit better than her average normal before yesterday's incident. To me it was almost miraculous -- and even more appreciated in the context of having euthanized Sage the previous night, ie really dreading the prospect of having to do the same for her within the next day or so. Her palpable nodes were also much smaller than they had been prior to her Elspar and to me smaller than they had been yesterday. So it could be that any lymphoma in her spine had been a bit slower to cause bad effects and also a bit slower to respond to the Elspar -- or I wonder , maybe the dying of lymphoma cells in her spine had caused the temporary neurological malfunction ??? (I only though of this last one as I am writing this.) Or alternatively , a 6th possible explanation for her incident would be that she fell (or was knocked into and down by another dog) fairly early in the day Sunday and thus spent the day unable to get up and go to any of the water bowls, thus accounting for becoming dehydrated (as she was passing a goodly amount of fluid through her urine due to being on a higher dose of pred), and lying on that left hind leg on an unpadded surface all day, thus resulting in the leg getting numb and not wanting to work for a while. I have seen in several elderly dogs who have lost a lot of their outer thigh muscle, as she has, that lying on an uncushioned surface for too long will cause that leg to not want to bear weight for a while after they get up. I've never seen it sosevere nor to last so long. But then, it is known that pred causes some muscle weakness, so maybe that combined with lying on pressure points on that leg for most of the day (if that is what happened (she cannot tell me how long she was trapped there) would account for the episode.
 
We agreed that the safest course of action for her was to leave her hospitalized another night and day, so that her IV fluids could be gradually reduced ("weaned") during the night and she could be observed for some hours afterwards. I will get to pick her up this evening after my 4:00 to 5:30 yoga class. Our appointment for her release is at 6 pm, which means that with luck I will be home in time to watch CSI at 9 pm. Yeah, I am joking, but all it would take is an emergency or more urgent care cases to keep me waiting at the end of the triage line : the timing of her release is merely a matter of my convenience and not one of her welfare.
(Eg yesterday we had agreed to meet at 6:15 after I got out of the 5pm to 6 pm Shelter Med 101 class, so I left promptly after class thus forfeiting oppertunity to hear talk about Advantage and Advantix and get a share of the free samples being given out and, of no small importance, a share of the generous amounts of pizza being provided. (The diet of vet students, residents, clinicians, and other Vet School staff is probably nearly 30% pizza by weight and at least 50% pizza by calories ; this is not a lifestyle and diet approved by the Surgeon General !) However , in reality Dr Grant was tied up with other clients until well past 7 pm, so I missed out on the goodies for nothing. But it was worth it because my little girl gets to come home and live contentedly a while.)
 
If it really was lymphoma in her spine, then the next time her remission falters or fails, it's likely that her rear end will go out of commission again. If so, then we will try that new drug, because it will be our last best hope for another period of grace. Or if she is in really bad shape and her eyes tell me she wants to quit, then I will let her go gracefully.
 
But for now, hallejullia, Princess is coming home !!! And of course from now on, when I am leaving the house for more than an hour or so , I will confine her to a portion that has carpet overlays and one or more soft cushioned dog-beds and at least two water sources. Good Dawg, when the Vet School decides to give Gerontology 101, maybe I should offer to do a guest lecture on "advising clients of practical home care issues."

UPDATE 4/27/05 : Because the re-enlargement of Princess's nodes narly 3 weeks ago indicates that she was faltering in her remission and that the drug protocol she had been on , a drug called CCNU, was no longer working well enough, she is now on a final "rescue" or "salvage" protocol called MOPP. It's a very old protocol, not much used any more except as a last resort effort after others have failed. Realistically we can hope for one to , if very lucky, three months of good quality life left for her. She has been having more trouble rising from a down into a stand, possibly because of the higher doses of prednisone; so I have to help her and when I am not home, I confine her to a safe area inside the house. She is still able to go for walks, still eats well, and is still alert to her surroundings and seems to be able to enjoy life. I am trying to give her extra attention as well as foods that she expecially likes.

She has been in Rescue for a bit over a year now, and that is a year that she would not have gotten after being abandoned by her Hawaii bound owners, may they fall off the cliffs of the Palii or into the mouth of Mauna Loa .

UPDATE 5/9/05 : For the past week I have known that her disease was progressing despite the MOPP protocol. Her nodes are enlarging again, her appetite is waning, and she has been getting weaker. Until today she has at least been comfortable. This morning she was very weak and would only eat small amounts at an offering. -- even especially tasty goodies. Sometime this afternoon, I think during the two hours I was away to go to Shelter Med class, I think she has decided to give up. We have a re-check appointment tomorow, otherwise I would be taking her in now. I have incontinence pads under her as she is unable to stand to pee. She is still drinking and I offer her water regularly. But now she won't eat at all. I will give her tylenol-codeine tonight so she can sleep more easily. I don't think she is in pain but I think she will need help to sleep. Turn out the lights and then turn out the light.

UPDATE 5/10/05